Overview • Mechanism & Patterns
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Toxicity of muscimol & ibotenic acid–containing mushrooms
Review of >300 cases: onset 30–180 min; mixed CNS excitation/depression, delirium, ataxia; most recover with supportive care.
Summary
Compares A. muscaria and A. pantherina; outlines dosing forms (dried caps, teas), common co-factors, and typical ED courses.
Moss MJ, Hendrickson RG, Graeme KA, et al. Toxicity of muscimol and ibotenic acid containing mushrooms. Clin Toxicol (Phila). 2019. PubMed
Classic • Chemistry & Toxicology
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Amanita muscaria: chemistry, biology, toxicology, ethnomycology
Cornerstone monograph: muscimol = GABAA agonist; ibotenic acid = glutamatergic agonist; anchors modern understanding.
Summary
Details historical/ethnographic uses, toxin chemistry, and pharmacology; still widely cited in clinical reviews.
Michelot D, Melendez-Howell LM. Amanita muscaria: chemistry, biology, toxicology, and ethnomycology. Mycol Res. 2003. PubMed
Severe • Includes a Fatality
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Two cases of severe A. muscaria poisoning (one death)
Not always benign: one patient suffered cardiac arrest with death days later; underscores need for vigilant monitoring.
Summary
Describes dose context, ECG/ICU course, and co-factors; practical red flags for disposition decisions.
Meisel EM, Patel A, Doty T, et al. Two Cases of Severe Amanita muscaria Poisoning Including Death. Wilderness Environ Med. 2022. PubMed
ED Case • Supportive Care
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Accidental A. muscaria poisoning (illustrated case)
Agitation, hallucinations, mydriasis; improved with supportive care and benzodiazepines—good bedside teaching case.
Summary
Clear timeline and vitals; includes photos and differential; emphasizes observation and avoidance of unnecessary antidotes.
Rampolli FI, Vastani N, Bizuneh Y. Accidental Amanita muscaria Poisoning. Cureus. 2021;13(3):e13829. PubMed
Intentional Use • Delirium
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Intentional A. muscaria ingestion leading to delirium
Adult self-medicating with fly agaric developed acute delirium; resolved with supportive care—counseling point for “wellness” misuse.
Summary
Highlights dose form (dried caps), timing to symptoms, and course; underscores risk messaging for recreational/“anxiolytic” use.
Maung AC, Mahmood A, Khasawneh FA. Accidental colourful mushroom poisoning – delirium, insomnia and confusion. BMJ Case Rep. 2023. PubMed
Neuropsychiatry • Prolonged Psychosis
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Prolonged psychosis after Amanita muscaria ingestion
Paranoid psychosis began ~18 hours post-ingestion and lasted 5 days—late deterioration is possible after initial symptoms fade.
Summary
Classic report detailing timeline, exam, and recovery with supportive care; cautions against early discharge in moderate/severe cases.
Brvar M, Mozina M, Bunc M. Prolonged psychosis after Amanita muscaria ingestion. Wilderness Environ Med. 2006;17(4):281–284. PubMed
Young Adults • Recreational Use
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Party ingestion series in 18–21-year-olds
Five youths ate dried caps seeking hallucinations; one lost consciousness. Illustrates dose variability and risk in first-time users.
Summary
Describes presentation, vitals, co-ingestants, and ED care; reinforces prevention messaging aimed at college-age experimenters.
Satora L, Pach D, Butryn B, Hydzik P, Balicka-Ślusarczyk B. Fly agaric (Amanita muscaria) poisoning—case report and literature review. Przegl Lek. 2005;62(10):1034–1036. PubMed
Pediatrics • Series
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Mushroom poisoning in infants & children (A. pantherina & A. muscaria)
Nine pediatric cases (mostly toddlers): abrupt CNS depression/ataxia with waxing/waning obtundation; most recovered with supportive care.
Summary
Historical but instructive series clarifying pediatric phenotype (vomiting uncommon, neuro signs dominant) and observation needs.
Benjamin DR. Mushroom poisoning in infants and children: Amanita pantherina and Amanita muscaria. J Toxicol Clin Toxicol. 1992;30(1):13–22. PubMed
Public Health • Product Contamination
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Neurotoxicity from “medicinal mushroom” product contaminated with muscimol
Supplement-market product likely contained muscimol → neurotoxicity; highlights regulatory/testing gaps and need for product analysis.
Summary
Clinical course, suspected source, and toxicologic reasoning presented; relevant to retail “functional mushroom” trends.
Ebbens EF, Van Pomeren T, Van Capelle CJ, et al. Neurotoxicity associated with a medicinal mushroom product contaminated with muscimol. Clin Toxicol (Phila). 2024;62(9):1082–1087. PMID: 39386889. PubMed
Diagnostics • Urine Assay (GC/MS)
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GC/MS confirmation of ibotenic acid & muscimol in urine
Validated method to detect toxins in patient urine—useful forensic/clinical confirmation when history is uncertain.
Summary
Describes sample prep, sensitivity/specificity, and application to real intoxication cases; complements NMR/CE-MS methods.
Stříbrný J, Ondra P, Marešová V, et al. GC/MS determination of ibotenic acid and muscimol in urine of intoxicated patients. Int J Legal Med. 2012;126(6):907–913. PubMed
Diagnostics • NMR Urine Test
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Rapid NMR detection of ibotenic acid & muscimol in urine
Non-chromatographic NMR method allows quick confirmation of Amanita toxin exposure in clinical settings.
Summary
Demonstrates reliable detection within hours after ingestion; complements GC/MS and CE-MS methods when toxicology labs are limited.
Deja S, Barg W, Malinowska E, et al. Rapid determination of ibotenic acid and muscimol in human urine. Magn Reson Chem. 2014;52(9):500-504. PubMed
Diagnostics • CE-ESI-MS/MS
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Capillary electrophoresis–MS detection of Amanita toxins
Sensitive CE-ESI-MS/MS assay for ibotenic acid, muscimol, and muscarine without lengthy prep—useful for forensic confirmation.
Ginterová P, et al. Determination of mushroom toxins ibotenic acid, muscimol and muscarine by CE-ESI-MS/MS. Drug Test Anal. 2014;6(9):894-900. PubMed
Neurology • EEG Findings
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Burst-suppression EEG after Amanita pantherina poisoning
Comatose patient exhibited burst-suppression pattern; recovered fully—illustrates severe CNS-depressant potential.
Ogawa Y, et al. Burst-suppression EEG with mushroom poisoning. Acute Med Surg. 2015;2(3):208-210. PMC
Analytical • Absorption Kinetics
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Absorption and urinary detection of ibotenic acid/muscimol
Establishes that both toxins appear in urine within one hour—supports early sampling for confirmation.
Vendramin A, et al. Amanita muscaria and A. pantherina poisoning: absorption and urinary detection kinetics. Toxicon. 2014;84:45-50. PubMed
Recreational Trend • 2023 Series
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Emerging risks of Amanita muscaria: recreational use case series
Four young adults intentionally consumed fly agaric for psychoactive effects—tremor, paranoia, hallucinations; all recovered.
Summary
Highlights resurgence of Amanita experimentation on social media; calls for surveillance and public education regarding potency variability.
Savickaitė E, Laužikaitė A, Baranauskas A, Kvietkauskas R, et al. Emerging risks of Amanita muscaria: case reports on recreational use. Medicina (Kaunas). 2025;61(2):188. PMID: 40641545. PMC
Informational only — not medical advice. Fly agaric and related species can cause severe neurotoxicity; seek emergency care immediately after ingestion.